Latent and overt maternal risks and outcomes of insufficient fetal growth

DOI

https://dx.doi.org/10.18565/aig.2026.62

Ziyadinov A.A., Novikova V.A., Radzinsky V.E.
1) N.A. Semashko Republican Clinical Hospital, Simferopol, Russia; 2) S.I. Georgievsky Medical Institute of V.I. Vernadsky Crimean Federal University, Simferopol, Russia; 3) Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russia

Objective. To investigate the associations between latent and overt maternal risk factors, timing of delivery, and the need for neonatal intensive care in pregnancies complicated by fetal growth restriction (FGR) or small-for-gestational-age (SGA) fetuses.
Materials and methods. A prospective cohort study was conducted at N.A. Semashko Republican Clinical Hospital Perinatal Center from 2018 to 2023. The study included 611 women with insufficient fetal growth (IFG): 435 with FGR and 176 with SGA.
Results. Maternal comorbidity associated with IFG was predominantly cardiometabolic in nature. However, in 45.5% of patients, the cause remained unclear (idiopathic), and occurred more frequently in FGR. Preeclampsia (PE) and type 1 diabetes mellitus (type 1 DM) were exclusive markers of FGR, whereas gestational and chronic arterial hypertension (GAH and CAH) and gestational diabetes mellitus (GDM) were more characteristic of SGA. FGR was exclusively associated with emergency delivery for fetal indications in cases of severe PE, unknown causes of IFG, and GAH. Precipitous labor was an absolute marker of FGR, whereas dysfunctional labor was a characteristic of SGA. Delivery within the recommended optimal gestational interval was achieved in only 37.64% of patients with IFG, more frequently in SGA cases, and may have occurred before the third ultrasound screening. Prematurity was exclusive to the FGR group. Iatrogenic prematurity accounted for 86.49% of all preterm births and was primarily associated with PE and CAH. An unknown cause of IFG was associated with delivery outside the optimal gestational interval in 46.76% of patients with FGR; in 9.9% of these cases, delivery occurred before the recommended interval. Neonatal intensive care (IC) was required in 73.16% of newborns, and 20.95% of these infants required respiratory support (RS). The need for IC combined with RS was observed exclusively in the FGR group. SGA, as a constitutional fetal characteristic, did not preclude the need for IC in the absence of a RS. Delivery before 39 weeks in SGA was predictive of neonatal IC requirements, whereas delivery before 35 weeks in FGR predicted the need for IC combined with RS.
Conclusion. In addition to maternal cardiometabolic disorders, latent IFG-related risks may emerge in 45.5% of patients either before the third ultrasound screening or at term. This contributes to missed opportunities for delivery within the optimal gestational window, particularly in the case of FGR. Patients with IFG are at an increased risk of emergency delivery and prematurity (34.02%, including extreme prematurity), of which 86.49% is iatrogenic. SGA, often regarded as a constitutional fetal characteristic, may be associated with GAH, CAH, and GDM. Neonatal IC was required in 73.16% of cases, with 20.95% additionally requiring RS, exclusively among infants with FGR. Prematurity is unequivocally associated with the need for IC. Timely identification of chronic and gestational maternal cardiometabolic disorders may facilitate the early detection of FGR and SGA and help determine the optimal timing and location of delivery, thereby minimizing neonatal risks.

Authors' contributions. Ziyadinov A.A. – conception and design of the study, data analysis, drafting and editing of the manuscript, interpretation of results, approval of the manuscript for submission; Novikova V.A. – conception and design of the study, statistical analysis and interpretation of results; Radzinsky V.E. – conception and design of the study, editing of the manuscript, approval of the manuscript for submission.
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.
Ethical Approval. The study was reviewed and approved by the Research Ethics Committee of the Peoples' Friendship University of Russia named after Patrice Lumumba.
Generative Artificial Intelligence. No artificial intelligence tools were used in the preparation of this manuscript.
Patient Consent for Publication. All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Ziyadinov A.A., Novikova V.A., Radzinsky V.E. Latent and
overt maternal risks and outcomes of insufficient fetal growth.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (6): 68-81 (in Russian)
https://dx.doi.org/10.18565/aig.2026.62

pregnancy

fetal growth restriction

small-for-gestational-age fetus

gestational age at delivery

latent risks of insufficient fetal growth

idiopathic cause of insufficient fetal growth

classification trees

Full text (in Russian)

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Received 20.02.2026

Accepted 09.06.2026

Arsen A. Ziyadinov, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology No. 1, S.I. Georgievsky Medical Institute of V.I. Vernadsky Crimean Federal University; Obstetrician-Gynecologist, Perinatal Center of N.A. Semashko Republican Clinical Hospital, 295017, Russia, Republic of Crimea, Simferopol, Semashko str., 8; Doctoral student at the Department of Obstetrics and Gynecology with the Course of Perinatology, Medical Institute of Peoples’ Friendship University
of Russia named after Patrice Lumumba, ars-en@yandex.ru
Vladislava A. Novikova, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology with the Course of Perinatology, Medical Institute of Peoples’ Friendship University of Russia named after Patrice Lumumba, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, vladislavan@mail.ru
Victor E. Radzinsky, Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of the Department of Obstetrics and Gynecology with the Course of Perinatology, Medical Institute of Peoples’ Friendship University of Russia named after Patrice Lumumba, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, kafedra-aig@mail.ru

Latent and overt maternal risks and outcomes of insufficient fetal growth

Ziyadinov A.A., Novikova V.A., Radzinsky V.E.

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